Clayton T. Coleman v. HHS - Influenza, Sweet's syndrome (2021)

Clayton T. Coleman, a forty-year-old male, filed a petition on March 7, 2018, alleging that he suffered from Sweet's syndrome and arthralgia as a result of an influenza vaccine he received on February 3, 2016.

Petitioner reported experiencing feverishness and body aches on the evening of the vaccination, with symptoms worsening over the weekend to include full body aches and fever. By February 7, 2016, he noticed a rash on his back and neck, which spread to his face, wrists, arms, shoulders, eyes, and hairline.

He also experienced severe joint pain in his wrists and thumbs, which later spread to his ankles, legs, back, and shoulders, causing numbness, burning, and tingling sensations. The pain was so intense that he was unable to hold a pen or walk for three months, significantly impacting his ability to participate in daily activities and care for his eight children.

He was able to continue working, with the exception of eight days off due to pain, and his condition slowed but did not prevent him from obtaining his engineer's license. Petitioner presented to his primary care provider, Dr.

Derek Einhorn, on February 9, 2016, who diagnosed bullous impetigo and prescribed antibiotics. The following day, dermatologist Dr.

Leonard Kerwin diagnosed a drug eruption and advised discontinuing Bactrim. On February 15, 2016, Dr.

Leonard Cetner noted the rash began two days after the flu vaccine and diagnosed a worsening unspecified dermatitis, with a differential diagnosis including serum sickness and erythema multiforme. A biopsy revealed a hypersensitivity reaction.

Petitioner saw ophthalmologist Dr. David Shepherd on February 16, 2016, who recorded an autoimmune reaction to the flu vaccine leading to eye issues.

Petitioner continued to see Dr. Kerwin and Dr.

Stephen Portnoy, a rheumatologist, who noted a possible hypersensitivity response after the flu vaccine and could not exclude an association with it. On June 30, 2016, dermatologist Dr.

David Fivenson diagnosed acute febrile neutrophilic dermatosis consistent with Sweet's syndrome and instructed petitioner to stop taking allopurinol, a medication he had been taking for years for kidney stone prevention, as a possible trigger. On July 22, 2016, Dr.

Portnoy diagnosed Sweet's syndrome by biopsy. By April 21, 2017, petitioner's rash and joint pain had resolved, though he experienced periodic joint pain.

Petitioner's expert, Dr. M.

Eric Gershwin, opined that the flu vaccine caused petitioner's Sweet's syndrome through abnormal cytokine production and inflammasome activation in a genetically susceptible host. He cited medical literature and case reports linking vaccinations, including flu vaccines, to Sweet's syndrome, and noted that while the exact genetic predisposition is unknown, scientific certainty is not required.

Dr. Gershwin also opined that it was unlikely allopurinol caused the condition, as petitioner had taken it for years prior to symptom onset.

Respondent's expert, Dr. Mehrdad Matloubian, disagreed, arguing that the theory of vaccine-induced Sweet's syndrome was speculative and lacked persuasive medical literature beyond rare case reports.

He suggested that associations between vaccines and Sweet's syndrome are likely coincidental and that a seasonal or infectious cause might be more plausible, noting that the pathogenesis of Sweet's syndrome is not fully understood. Dr.

Matloubian also stated there was no evidence of petitioner's genetic susceptibility in his personal or family history. Special Master Nora Beth Dorsey found that petitioner established a sound and reliable medical theory of causation (Althen Prong One), a logical sequence of cause and effect linking the vaccine to the injury (Althen Prong Two), and a proximate temporal relationship of three to four days between vaccination and symptom onset (Althen Prong Three).

The Special Master noted that while the specific genetic susceptibility is not known, the medical literature supports the theory of genetic contributions to Sweet's syndrome pathogenesis. The Special Master also found that the treating physicians questioned an association between the flu vaccination and the petitioner's condition, and that the temporal relationship was medically acceptable and consistent with the proposed mechanism of injury.

Therefore, the Special Master ruled that Mr. Coleman is entitled to compensation, with damages to be determined in a separate order.